Background
The 'open' (external) and 'closed' (endonasal) rhinoplasty approaches remain a subject for debate. Semiopen approach was proposed by Inchingolo and colleagues in 2012 with the advantages of the open technique without division of the columella.
Patients and methods
A randomized prospective single-blinded study was conducted. Thirty patients were divided into two groups. In group A, 15 patients underwent rhinoplasty with the endonasal approach, whereas in group B, 15 patients were subjected to rhinoplasty with the semiopen approach. Parameters used for evaluation were recorded intraoperatively, at 1 week, and 3 months postoperatively.
Results
In group B, the operative time was longer and tip accessibility was better compared with group A, with a high statistical significance. Postoperative edema was more in group B than in group A, with a significant difference in the immediate postoperative period.
Conclusion
The semiopen approach shows better tip accessibility compared with the ordinary closed approach, with fewer incisions compared with the tip delivery technique and with no need for columellar division as in open approach. However, it has a longer operative time with more postoperative edema compared with the closed approach. Therefore, the best use of this approach is for cases in which tip modification is needed, especially if concomitant nasal dorsum modification is also needed.

Objective
The aim of this study was to evaluate the relationship between the level of total serum IgE and the prognosis of allergic fungal sinusitis, possibility of recurrence and level of aggressiveness.
Type of the study
This study was a prospective controlled one.
Patients and methods
Forty patients who were diagnosed as having allergic fungal sinusitis were randomly divided into two equal groups. One group (group A) received postoperative systemic steroids, whereas the other group (group B) received postoperative local steroids only. The patients were followed up for 6 months with endoscopy and IgE level evaluation.
Results
The total number of patients who had recurrence of the disease 6 months postoperatively was 17. Six of them were from group A (systemic steroids) and 11 were from group B (local steroids only).
Conclusion
Allergic fungal sinusitis should be treated with minimal surgical or endoscopic procedures, followed by local and more important systemic steroids for a prolonged period. Patients should be followed up at close intervals postoperatively using nasal endoscopy and more importantly serum IgE (total and if available fungus specific) as it is a good indicator to the future possibility of recurrence and thus the possibility of resurgery or further medical treatment.

Objective
The objective of this study was to evaluate the effect of intranasal corticosteroid versus hypertonic saline irrigation on the nasalance scores in patients with vasomotor rhinitis (VMR).
Patients and methods
The study was conducted on 71 patients recruited from the Otolaryngology Department, Kasr El-Aini Hospital, Cairo University, with a history of nasal obstruction for at least 6 months, clinical and endoscopic evidence of VMR, and negative skin prick test. The patients were subjected to nasometric evaluation to obtain their nasalance scores before treatment. The patients were then randomly classified into two groups: group A, which included 33 patients who were instructed to apply mometasone furoate nasal spray two puffs in each nostril once per day for 3 months, and group B, which included 38 patients who were instructed to apply hypertonic saline nasal spray three times per day for 3 months. Patients of the two groups were re-evaluated by means of nasometry to assess the change in their nasalance scores after each treatment plan.
Results
The mean pretreatment nasometry score for group A was 34.55 ± 7.71, the minimum score was 18.7, and the maximum score was 48. The post-treatment nasometry score for the same group showed a mean of 46.44 ± 7.76 and ranged from a minimum of 29.9 to a maximum of 58.2. The difference between the two scores was found to be statistically significant (P = 0.014). As regards group B, the mean pretreatment nasometry score was 36.04 ± 7.36, the minimum score was 17.4, and the maximum score was 47.3. The post-treatment nasometry score for the same group showed a mean of 45.57 ± 7.4 and ranged from a minimum of 29.3 to a maximum of 55. The difference between the two scores was found to be statistically highly significant (P = 0.001).
Conclusion
It appears that intranasal hypertonic saline is highly effective in the treatment of VMR and approaches the effect of intranasal corticosteroids.

The aim of this study was to report a case of sinonasal meningioma in Sudan. Meningiomas account for nearly 20% of all intracranial neoplasms and are the second most common tumor of the central nervous system. Primary meningiomas of the nose and paranasal sinuses are extremely rare. The clinical and radiological features of these tumors are nonspecific, and consequently an accurate diagnosis requires histologic evaluation. A 62-year-old woman from North Sudan presented to our hospital in May of 2016 complaining of right nasal obstruction associated with bloody nasal secretion and proptosis. Endoscopic endonasal examination revealed a soft mass in the right nasal cavity between the septum and the middle and superior turbinates posteriorly. MRI revealed the presence of a lobulated mass with soft-part density in the right nasal cavity (middle meatus) and the right ethmoid sinus invading the orbital contents and extending intracranially. The biopsy of the lesion revealed nodular neoplasm composed of regular cells arranged in whorled pattern. One psammoma body was noted and there was no evidence of pleomorphism or necrosis. The features are consistent with sinonasal meningioma. The patient was referred to the oncological department because it was an unresectable malignant meningioma and surgery was not feasible and would create more complications. Meningiomas involving the nasal cavity and paranasal sinuses are rare. The mortality is low, and its lethality is due to the complications of the surgery and injury of vital structures. Complete surgical extirpation of sinonasal tract meningiomas has an overall good prognosis. Hence, endoscopic nasal approach is an excellent surgical option in these cases, due to its low morbidity and satisfactory lesion resection.

Antrochoanal polyp (ACP) is a common unilateral benign lesion that originates from the maxillary sinus mucosa and protrudes through the choana into the nasopharynx. Patients usually present with progressive unilateral nasal obstruction. Rarely, bilateral ACPs could be encountered in clinical practice. It is important to recognize such unusual entity to spare patients unnecessary investigations and prolonged medical and aggressive surgical treatment. Generally, ACP is managed surgically with complete excision including the mucosa of origin to reduce the risk for recurrence. In this report, we present a rare case of bilateral simultaneous ACPs that was managed successfully with endoscopic excision. Review of the literature as regards the etiology, pathophysiology, different clinical presentations, and management aspects of ACP is also presented.

How I do it: direct transnasal endoscopic posterior ethmoidectomy with the intact bulla technique

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Reda Kamel, Hesham MansourDOI:10.4103/2090-7540.200614

In lesions affecting both anterior and posterior ethmoids where surgery is indicated, total ethmoidectomy as part of functional endoscopic sinus surgery is the state of the art. In solo posterior ethmoid lesions, there is still controversy in terms of the most direct and least destructive approach. In these cases, it is not justified to disturb the integrity of the bulla ethmoidalis and/or the middle turbinate. In this article, a novel approach to the posterior ethmoid is presented that does not disrupt the integrity of the ostiomeatal complex.